Provider Demographics
NPI:1033387717
Name:ANDERSON, NICOLE EDITH (RD, CD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:EDITH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N 143RD ST
Mailing Address - Street 2:APT 3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-7052
Mailing Address - Country:US
Mailing Address - Phone:508-308-7343
Mailing Address - Fax:
Practice Address - Street 1:547 DAYTON ST
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3431
Practice Address - Country:US
Practice Address - Phone:425-771-5166
Practice Address - Fax:425-670-2807
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered